Reducing harm

February 10, 2017

Expert panel looks at how to address the growing opioid crisis

STORY_IMAGE_Panel_Opioid_Crisis

Experts came together for a panel discussion on the current opioid crisis on Monday, February 6 as part of a lecture series hosted by the Faculty of Nursing and Faculty of Health and Community Studies. Speakers included Dr. Elaine Hyshka, assistant professor with the University of Alberta’s School of Public Health; Dr. Joanna Oda, medical officer of health with Alberta Health Services, Edmonton Zone; Petra Schulz, faculty member, Faculty of Health and Community Studies, MacEwan University and founding member of Moms Stop The Harm; Holly Symonds-Brown, assistant professor, Faculty of Nursing, MacEwan University; Marliss Taylor, program manager for the Streetworks program; Dr. Hakique Virani, public health and addictions specialist, University of Alberta; and Jordan Westfall, president of the Canadian Association of People Who Use Drugs


Petra Schulz, a MacEwan University faculty member, never planned to be a harm reduction advocate. “I too was once a soccer mom,” she told a standing-room-only audience in the Kule Theatre.

During the more than two years since her son Danny died of an accidental fentanyl overdose, Petra has been sharing her son’s story with students in the university’s Faculty of Nursing, advocating for harm reduction, and calling for action in the current opioid crisis.

In an effort to expand awareness across the university and to create dialogue, Petra proposed a panel discussion, hosted by the Faculty of Nursing and the Faculty of Health and Community Studies, that brought together experts from a range of backgrounds—health-care providers, community members, educators, academics and people who use drugs—to share their perspectives.

Death count just the tip of the iceberg

Petra’s son Danny was one of 117 people who died due to fentanyl overdose in 2014. The death toll more than doubled in 2015 at 257, and reached 343 in 2016.

But deaths per year, no matter how alarming, don’t tell the whole story, explained Dr. Joanna Oda, medical officer of health with Alberta Health Services, Edmonton Zone.

“Deaths really represent the tip of the iceberg,” she said. Look a little bit deeper, she explained, and you’ll find about 300 emergency department visits per month in Alberta attributed to opioid overdoses. Add urgent care centre visits and that number almost doubles. Prescribing opioids in a way that is not safe, she said, is another, deeper part of the problem.

“It’s important for us to remember that this is a public health crisis,” said Joanna. “We can’t arrest our way out of this problem. We can’t detox our way out of this problem. Our solutions really lie in a harm reduction model.”


 

Seek to cause less harm

That model, said Joanna, comprises several factors including the take-home naloxone program, opioid dependence treatment and supervised consumption sites. “All of these are evidence-based public health interventions and they're a necessary part of our responses.”

Marliss Taylor, program manager at Streetworks, which operates Edmonton’s only needle exchange program, shared her organization’s definition of harm reduction—one she said recognizes the importance of both scientific evidence and lived experience.

Harm reduction is not encouraging substance use, enabling drug use or giving up on people, she said. “Harm reduction does quite the opposite. It opens the doors for people to access services and creates more support for positive change.”

Those services include things like making naloxone kits available, enhanced drug substitution programs (e.g., methadone), increased needle exchange capabilities, supervised consumption services, on-the-spot drug testing (so people who use drugs can test a drug to see what’s in it), better surveillance numbers and creating a culture where people are not afraid to ask for help.


Glossary 

Opioid | A class of medications with similarities to opium derives from the poppy plant. Includes both prescription and illegal drugs. Examples include fentanyl, heroin, morphine and hydromorphone.

Overdose | Taking more of a substance than is typically normal or recommended. Can be intentional or unintentional.

Naloxone | A drug used to treat opioid overdoses. It blocks or reverses the effects of opioids, such as extreme drowsiness, slowed breathing or loss of consciousness.

Relapse | A return of a disease or illness after a partial recovery from it.

Needle exchange | A service that allows users who inject drugs to obtain hypodermic needles and syringes at little or no cost.


Providing harm reduction services, Marliss said, also involves thinking openly about who is using substances, being more compassionate and fighting stigma and discrimination.

She spoke about how people who use drugs are often seen as being on one of two poles: those who are street involved versus those who are in society’s mainstream. Both groups are vulnerable, she said. One because we don’t care about them, and the other because they are underserved and invisible.

Involve people who use drugs into finding a solution

Harm reduction also “includes the meaningful and active involvement of people who are using substances,” said Marliss.

Jordan Westfall, president of the Canadian Association of People Who Use Drugs, agreed.

“Many institutions have failed us,” he said. “It’s unsurprising because the people most aware, the people most knowledgeable, the people who know our system most intimately, are not sitting in these institutions.”

Things cannot be expected to change, he said, without substantial policy reform, including life-saving interventions—opening sites where drug possession is decriminalized, a good samaritan 9-1-1 overdose law that would decriminalize drug possession at the scene of an overdose, and increased ability to prescribe heroin and hydromorphone as treatments for chronic relapsing opioid dependence. Jordan ended with the statement that “drug decriminalization could end this epidemic.”

“Those are high-yield interventions that will change the face of this crisis,” said Dr. Hakique Virani, public health and addictions specialist, University of Alberta. He also agreed that involving people who use drugs in policy interventions is critical.

“We’re doing things to people that affect them in a way that could be fatal and we don’t ask them what they think.” Not including people who use drugs in policy decisions, he added, results in policies that don’t work and make people extremely unsafe.

Take action

Hakique encouraged the more than 250 people in the room to have their voices heard, suggesting they ask their provincial government to declare a public health emergency and improved surveillance of the crisis itself, and implore the federal government to address the impact of the fentanyl crisis in special populations including people in the corrections system and First Nations (who he explained were hit hard and fast with the prescription opioid crisis—the Blood Tribe in southern Alberta declared a public emergency in response to fentanyl almost two years ago).

“When H1N1 happened, we had people available around the clock to assess folks and provide them with antiviral therapies and we had vaccine clinics to administer a vaccine,” he said. “We need to be taking a similar urgent approach to people who want treatment.”

The final words of the panel discussion went to Hakique. Using drugs doesn’t make someone less human, he said, “but what might make us less human is if we create environments that make it extremely unsafe for them to make choices. I think that’s where the conversation needs to eventually go.”

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